What is an ABN?

An Advance Beneficiary Notice of Non-coverage (ABN) is a form used in the US Medicare system to inform patients that a certain item or service they’re about to receive is likely not covered by Medicare. Its purpose is to ensure you, the patient, understand the potential financial responsibility before receiving the service. Here’s what you need to know about ABNs: When you get an ABN:

• You’ll receive an ABN if your doctor or healthcare provider believes Medicare will not pay for a specific item or service you’re about to get. This could be for various reasons, such as:
  1. The service being considered not medically necessary.
  2. The service being considered custodial care, like help with bathing or dressing.
  3. You not meeting the criteria for covered home health services.
  4. The service being experimental or investigational.
• ABNs are only used with Original Medicare (Parts A and B), not Medicare Advantage plans.

What the ABN tells you:

• The ABN should clearly list the specific item or service that Medicare may not cover.
• It will provide an estimate of the cost you would be responsible for if Medicare denies coverage.
• It will explain why Medicare may deny coverage and your options for appealing the decision.

Your choices after receiving an ABN:

• Accept the service and pay the cost: After reviewing the ABN, you can choose to receive the service even if Medicare won’t cover it. You’ll be responsible for the full cost.
• Decline the service: You can decide not to receive the service if you’re concerned about the cost or disagree with the provider’s reasoning.
• Ask for more information: You can discuss the service and the ABN with your provider to get more clarification or explore alternative options.

Important things to remember:

• Getting an ABN doesn’t guarantee that Medicare will deny coverage. The final decision will be made by Medicare after the service is provided.
• Even if you receive an ABN, you have the right to appeal Medicare’s denial of coverage.
• It’s important to carefully review the ABN and ask questions if you have any concerns before making a decision about the service.

I hope this explanation clarifies what an ABN is and its significance in the Medicare system. If you have further questions or need more specific information about your situation, it’s always best to consult with your doctor or Medicare directly.

ABN Form (English and Spanish)

ABN Form Instructions